PREFACE
J Oral Maxillofac Surg
Accelerated Orthognathic Surgery and
Increased Orthodontic Efficiency:
A Paradigm Shift
“Once a paradigm shift has occurred, a veritable explo-
sion of new ideas and information leads to rapid advances in
the field.”—Thomas H. Kuhn
An explosion of technological advances has influ-
enced the present and future treatment of virtually all
orthognathic surgery and orthodontic patients. The
efficiency, duration, affordability, and convenience of
such treatment will be changed forever. This JOMS
issue describes how a paradigm shift will take place
by a global revolution of surgical education by virtual
imaging technology and robotic surgery.
With excessive health care costs and long treat-
ment times, the frequency of orthognathic surgery
has declined dramatically. As a consequence, many
facial deformity patients and malocclusions have gone
untreated, or have been treated inefficiently over a
long period of time at excessively high costs. These
existing economic forces and technological develop-
ments have forced the transition from hospital-based
to outpatient surgery.
With the use of new accelerated surgical orthodon-
tic techniques, treatment can be accomplished more
efficiently, predictably, affordably, and rapidly in con-
venient outpatient settings.
All who read this special series will become a part
of a paradigm shift in surgical orthodontics and will
be forever changed in their approach to treatment of
complex or simple maxillofacial deformity patients
and malocclusions. We promise a memorable learning
experience.
The reader will become familiar with the latest
techniques and advances in surgical orthodontics.
Surgeons, orthodontists, periodontists, and any other
interdisciplinary team members interested in learning
the latest innovations and advances in efficient and
rapid orthodontics coupled with outpatient surgery,
will find this special series new and challenging.
Medical imaging, information-guided therapies, dem-
onstration of workflow at work stations in a digital and
office-based setting, virtual imaging for virtual splints
and in-office planning and treatment of maxillofacial
deformities, electronic imaging and interdisciplinary
electronic communication are precisely described
and illustrated.
2043
67:2043-2044, 2009
The focus is on efficient and rapid orthodontic
techniques supplemented by adjunctive corticoto-
mies and osteotomies, temporary anchoring devices
as well as office-based orthognathic surgery. The new
role of integrated 3D patient analysis with fusion of
clinical, radiographic, and model information, virtual
planning and virtual splints in a virtual workplace are
illustrated. Readers will be delighted and amazed at
the efficiency of virtual planning and virtual splints
without the need for anatomic model surgery of plas-
ter models.
Digital orthognathic planning is not a “futuristic” tech-
nique, it is here today for all of us to use and enjoy. Many
years of research have led to a predictable system for
planning and transfer of the plan to the patient via
CAD/CAM splints. Not only will the use of digital tech-
nology reduce surgeon planning time (model surgery)
and cost, but it will also provide more favorable out-
comes by focusing on the bony anatomy level for indi-
vidualized osteotomy planning and design.
Sections of the special series (presented in this
issue and a future issue of JOMS) are devoted to the
following subjects:
● Role and application of 3D patient analysis and
treatment
● Various surgical techniques to facilitate rapid
orthodontics
● The role of temporary anchoring devices
● Office-based or outpatient general anesthesia and
surgery
● Teleconsultation and communication between
providers and patients
● Acceleration of tooth movement that is predict-
ably faster than conventional orthodontics
● A learning revolution of advances in robotic sur-
gery and virtual surgical simulation
● Closure of anterior open bite by orthodontic in-
trusion and compression osteogenesis by TADS
facilitated by simple corticotomies or osteoto-
mies in an office setting
● Cost-efficient ambulatory orthognathic surgery
In reading these contributions, consider the paradigm
shifts that they represent. These include:
2044
● Computerized surgical assessment, plan-
ning, and execution: Fully computerized 3D
treatment planning, virtual dental casts computer
milled splints, navigation guided surgery, and ro-
botic surgery are all on the verge of providing
extreme accuracy and predictability for efficient
morphologic correction of skeletofacial deformi-
ties.
● Ambulatory/office-based orthognathic sur-
gery: Eliminating the need for hospitalization
with simplified surgical plans allows for markedly
decreased costs and early recovery with an ex-
cellent patient safety record.
● Maxillomandibular advancement as the pre-
ferred method for treatment of obstructive
sleep apnea: Outcome studies now demonstrate
that maxillomandibular advancement is the most
reliable means of addressing sleep apnea for many
patients. Refinements of this technique along with
improvements in outcomes with various airway
enhancement options are emerging.
● Surgically facilitated orthodontic therapy:
Interdental corticotomy/osteotomy, often with
less traumatic cutting instruments such as the
ultrasonic knife, has re-emerged as a means of
shortening the duration of orthodontic care.
● Globalization’s impact on elective surgery:
The ability to diagnose and treat patients any-
where will drive competition in surgery as it has
PREFACE
in manufacturing. Globalization is having a major
impact on how skeletofacial deformities are diag-
nosed, worked-up, and treated.
● Speedy orthodontics: The technique Speedy
orthodontics (SO) allows for precise control of
anterior segmental retraction in protrusive adult
patients and posterior segmental intrusion in pa-
tients with open bite deformities. This technol-
ogy is powerful, easy to apply, and is a significant
adjunct to traditional surgical orthodontics.
● Orthopedic traction of the maxilla with
miniplates—a new perspective for treat-
ment of midface deficiency: This new treat-
ment approach allows the option of improving
the facial profile during the growth period with-
out any dental compensations.
JOMS readers will not only gain new knowledge
from this special issue. You are afforded the opportu-
nity to advance and transform your practice in the
management of skeletofacial deformities.
WILLIAM H. BELL, DDS, Co-Editor, Special Issue
RICHARD A. FINN, DDS, Co-Editor, Special Issue
PETER H. BUSCHANG, PHD, Co-Editor, Special Issue
© 2009 American Association of Oral and Maxillofacial Surgeons
doi:10.1016/j.joms.2009.07.005